A Mixed Methods Process Evaluation of the Promoting Resilience in Nurses Randomised Controlled Trial

AIM: To explore factors in the implementation of the Promoting Resilience in Nurses program that may help explain variation in outcomes between intervention and control groups in the randomised controlled trial of the program. DESIGN: A convergent mixed methods process evaluation conducted alongside a randomised controlled trial. METHODS: Data collection included participant satisfaction surveys, follow-up participant interviews, unit/team manager surveys on barriers and facilitators to staff program participation, and a program fidelity survey. Quantitative data underwent descriptive analysis, and qualitative data were thematically analysed. Findings were integrated with trial outcomes using joint display to generate meta-inferences. RESULTS: Nurses reported high program satisfaction. Both nurses and managers found the program valuable and supported its wider implementation. Barriers to implementation included heavy workloads and staff shortages. Meta-inferences indicated that positive changes in nurses' trial outcomes resulted from strong program fidelity (95% full delivery) and the program's provision of cognitive and emotional self-regulatory skills, stress management and coping strategies and interpersonal skills. CONCLUSION: Implementing this effective resilience program requires stakeholder support to address implementation barriers and embedding of the program into standard professional development. IMPLICATIONS FOR THE PROFESSION: Maintaining nurses' wellbeing, resilience, and practice is a shared responsibility. Healthcare organisations can provide nurses with wellbeing resources and support, including effective resilience interventions. Nurses can utilise these resources and engage in self-care to maintain their wellbeing and practice. IMPACT: This is the first reported process evaluation of a nurse resilience program. Identified implementation factors help explain nurses' positive mental health and wellbeing program outcomes and barriers and facilitators to wider program implementation. REPORTING METHOD: The Good Reporting of A Mixed Methods Study (GRAMMS) was used to inform the reporting of this study. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. TRIAL AND PROTOCOL REGISTRATION: The Promoting Resilience in Nurses trial, in which this process evaluation is embedded, was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620001052921) on 15 October 2020. Full details are accessible at the registration website (https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380026). The protocol of this process evaluation has been published in the International Journal of Mental Health Nursing (doi.org/10.1111/inm.12989).